33. WHO WANTS TO LIVE FOREVER?

Some people have a peculiar approach to mortality. They accept that they are going to die, live with it, and get on with their lives. There are even people—and I have met some—who are perfectly at ease with the fact that one day they will no longer exist, that their heart will stop and they will plunge headlong into an insensible, eternal void.

And then, of course, there are those who would willingly end their own lives in the event of impending infirmity, be it mental or physical; people who embrace the idea of euthanasia and are ready to terminate themselves the moment they start to forget why they went into the kitchen. My father, for instance, used to insist—only half jokingly—that if he ever started to lose his mind we were under strict instructions to take him out into the paddock and shoot him (thankfully, he departed with his marbles intact—which was just as well, as we didn’t have a gun, or a paddock). I, on the other hand, think about death—by which I mean whole proper minutes spent staring vacantly into space wrestling with the bitter truth of my own mortality—several times a day. If I only had a dollar for every time someone said, “Cheer up. It might not happen!” … But it will! That’s why my face looks like this.

I can tell you exactly when this all began: I was at school staring out of the classroom window one sunny afternoon, when I suddenly realized that I would one day die, and the world would continue without me! If I hurled myself through the first-floor window and plummeted onto the basketball court below, cars would still drive, people would still watch TV, and, after the school caretaker had administered a pile of sawdust, Miss Weddick would quiet the class down and continue to explain why water goes the other way around down the drain in Australia.

Which is why, as I limp toward middle age, my body and mind slowly disintegrating in ever-more-humiliating displays of decrepitude, I have vowed to cling to life for as long as I can. Never mind that I may become an incontinent, gibbering wreck and everyone will be sick of the sight of me, my liver-spotted claws shall grip the hands of my nurses insistently as they tend to the life-support machine beside my bed. I plan to be a burden to my children as long as I possibly can. A “good innings,” as we say in England, isn’t going to do it for me, I can tell you, and as for “three score years and ten,” five score and then some is more like it.

Gerontologists believe that the human body ought in theory to be able to last until well past one hundred and twenty years—the oldest person ever was a Frenchwoman who lived to the age of one hundred and twenty-two and a half. They say, too, that only around 25 percent of the causes of death and aging is found in your DNA; the rest is within your control. Hence, I am a sucker for all of those health-scare stories that the papers run every day; I lap them up as gospel, worrying over my diet, my lack of exercise, and my stress levels. Only my insatiable gluttony, a susceptibility to addictions, inherent indolence, and a fundamentally weak character have stopped me from becoming a vegan. No, instead of making radical changes to my life, I am on a constant quest for some kind of healthy-living magic bullet, the secret foods and lifestyle tips that will prolong my life and somehow, against all rational belief, keep my tired old body going for another seventy years or so.

So while Lissen and the boys had been dreaming of Okinawa’s idyllic sandy beaches and tropical seas, it was in fact my desperate fear of a godless death that had brought us to the paradise islands of southern Japan.

Okinawans, you see, know the secret of eternal life, or at least the secret of living a healthy, active life well into three digits. They live longer than anyone else on earth, and unlike others who claim this title—the people of the Hunza Valley in Pakistan or the Ecuadorian Andes, for instance—they can prove it, having kept meticulous official birth records since 1879. And they don’t just cling to life courtesy of expensive medicines and machines that go ping; elderly Okinawans are active, independent, contribute to society, and remain healthy and mobile up to and beyond one hundred years of age, into the realms of the so-called supercentenarians. In Okinawa, if you meet an octogenarian, there is a good chance his or her parents are still alive.

The three leading killers in the Western world are heart disease, strokes, and cancer, but the Okinawans suffer from them less than any other people. Out of one hundred thousand people only eighteen a year die from heart disease compared to over a hundred in the United States. Of course, the Japanese in general are world leaders in terms of life expectancy: Japanese women have a life expectancy of 87 years, the highest in the world, while the men have the fifth highest, with eighty years (San Marino in Italy is first, which hardly counts as a country). And Japan has over 40 percent of the world’s so-called supercentenarians, aged 105 and over, and has often boasted both the oldest man and woman alive (although, for obvious reasons, these titles change quite frequently). This in itself would be reason enough to look more closely at the Japanese diet and lifestyle—at why, for example, only 3 percent of Japanese are considered obese, compared to 30 percent of Americans—but the longevity of Okinawans is a special case indeed. They have over two and a half times as many centenarians per capita as the mainland. As I write this, there are over 800 centenarians on Okinawa out of a total population of 1.31 million, the highest ratio in the world. (Japan as a whole now has over 60,000 centenarians out of a population of a little over 127 million, compared to 80,000 in the United States, with almost three times the people—and their number has doubled over the last decade.)

The Okinawans are clearly doing something—several things—right. For someone with a morbid fear of death (is there any other kind?), there was no better place to go in search of tips.

The longevity of the mainland Japanese is a fairly recent phenomenon; until the seventies, the Swedes held the record for long life, yet the Okinawans have a reputation for healthy living that dates back centuries, perhaps millennia. The Chinese, who have traded with the Kingdom of the Ryukyus since the third century B.C., referred to it as the “Land of the Immortals.” Some even claim that the ancient Chinese myth of Shangri-la is about Okinawa.

On the other hand, there are many factors that mitigate against the Okinawans living long. For a start, Okinawans are the poorest people in Japan, thus undermining all conventional wisdom correlating health with income. Okinawa has always been beset by typhoons and famine, its people forever picking themselves up, dusting themselves off, and starving all over again. Periodically, outsiders have invaded and brutally subjugated what was an avowedly nonmilitary, peaceful country where, for a time, all weaponry was banned and guitars took the place of swords. The Japanese Shimazu clan came in 1609, imposing harsh taxes and using the islands as a trading route to China at a time when the country was supposed to be closed to the outside world. In the mid-1850s, Commodore Matthew Perry—hardly barbaric, but still an aggressive outsider—based his fleet in Okinawa before sailing to Japan with the intention of opening it up like a reluctant oyster. And then, of course, the Americans came again during World War II. Over a quarter—some say as much as a third—of the population died, a large proportion of them having been persuaded to commit suicide by the Japanese rather than surrender (tragically, this happened only some weeks prior to their traumatic surrender when Emperor Hirohito reluctantly conceded, in his first-ever public speech, that “the war has not necessarily developed to Japan’s advantage”). And last but very much not least, the place is absolutely infested with poisonous snakes, as testified to by the various puncture marks several locals were to show us during our stay.

The reasons behind the mainland Japanese’s longevity are more obvious. After the war, rampant economic growth improved health care immeasurably, stamping out such deadly diseases as tuberculosis. They started to eat more protein and animal fats. The average height increased by three inches. But perhaps the biggest single contributing factor to the improved health of the nation was a reduction in their salt intake in the early seventies. Salt was the single greatest weakness of the Japanese diet, an excessive intake of which was blamed for their high incidence of strokes. They still continue to consume more salt than we do in the West (the Japanese government recommends twelve grams per day; Western governments tend to recommend six grams) but in 1970 the Japanese government imposed reductions on levels of salt in soy sauce. After that, there was no stopping them. Incidents of stroke declined dramatically, and it has really been only their recent enthusiasm for Western fast-food trends that has been attributed to the rise in obesity and cholesterol levels. But what makes the Okinawans so exceptional?

I had made contact with one of the leading experts on Okinawan longevity, a Canadian gerontologist, Dr. Craig Willcox, who lives in Okinawa. Together with his twin brother, Bradley—now based at Harvard—and local gerontologist Dr. Makoto Suzuki, he started the government-funded Okinawan Centenarian Study in the midseventies.

A few years ago, the three of them published The Okinawa Program: How the World’s Longest-Lived People Achieve Everlasting Health—And How You Can Too. It went on to become a New York Times bestseller, and the brothers have even been on The Oprah Winfrey Show.

One morning a week or so after arriving on Okinawa, I left Lissen and the kids to various beach-themed activities (crab goading, purposeless digging) and drove back down south to the capital, Naha, where the Okinawa Research Center for Longevity Science is based, at Okinawa International University, to meet Dr. Willcox.

Dressed in a Hawaiian-style shirt, with thick, shoulder-length hair and clear, tanned skin, Willcox was a persuasive ad for his own program. I asked how old he was. He glanced at the students working behind us and whispered mock conspiratorially, “Forty-six, but don’t tell anyone.” I’d be lying if I said he looked ten years younger, but he did at least look a very good forty-six, which was frankly all the hope I needed.

After a brief introductory chat, we decided to continue our discussion over lunch. Willcox knew just the place, a small wooden shack a few hundred yards from the campus. There we ordered some classic Okinawan dishes and got down to the nitty-gritty.

Just how healthy were the Okinawans? “They have low cholesterol and suffer less from heart disease than anyone else, they are not big smokers or drinkers, and they have among the lowest levels of [the amino acid] homocysteine in the world—homocysteine causes at least 10 percent of heart disease deaths,” Willcox said, tucking into a plate of goya champaru, a classic Okinawan dish featuring stir-fried goya—a kind of knobby, bitter cucumber that has been shown to lower blood sugar in diabetics and has also been used to treat AIDS. “They have a low risk of arteriosclerosis. They have low instances of stomach cancer, which the rest of the Japanese suffer from. The Japanese have also historically had a high rate of strokes, but Okinawans have never eaten as much salt. They have a very low risk of hormone-dependent cancers, such as breast and prostate cancer. They eat three servings of fish a week, on average. They tend to use canola oil to fry with, which is even healthier than olive oil. They eat plenty of whole grains, vegetables, and soy products, too. And they eat more tofu and more konbu seaweed than anyone else in Japan. Squid and octopus, which they also eat a lot of, are rich in taurine, which is believed to lower cholesterol and blood pressure.”

I was scribbling furiously at this point, so Willcox paused to let me catch up and take a few mouthfuls of the goya champaru. I had tried to eat some goya earlier in our trip, in Kyoto. I’d picked one of these gnarly cucumbers—some call them “bitter melon”—out of the vegetable section in the supermarket and taken it home to give to the kids in their daily midafternoon raw fruit and veggie snack. Asger had taken a tentative bite before spitting the entire mouthful out into my hand. I had tried it and also found it impossibly bitter, consigning it to the “What are they thinking of?” category of unpalatable Japanese foodstuffs. But here, fried with egg and pork, its bitterness was subdued and helped cut through the fattiness of the dish.

Dr. Willcox continued, “They have strong bones, from the fish they eat, and, of course, they get lots of sun, plus more vitamin D from soy products. They have low dementia rates, which might be linked to the ginkgo nuts they eat, or it might be the sweet potatoes.”

Ah yes, the Okinawan sweet potato. I had tried these the night before at a restaurant across the street from our hotel. Okinawan sweet potatoes, while looking from the outside essentially like the orange variety we get at home, are the most extraordinary deep purple inside, the kind of color, almost artificial in its intensity, that you rarely find in nature. It is the color of a bishop’s miter, or Prince’s underpants—very, very purple. And they taste sensational, particularly as tempura, which is how I had tried them—not too sweet, and with a pleasant, flowery aftertaste and soft, almost creamy texture. I had also tried sweet-potato ice cream, another Okinawan specialty. As ice cream, it loses its potato-ishness, and the floral sweetness comes to the fore. It went straight on the “things to export from Japan to make the world a better place” list, just below soft-closing toilet seats and above disposable umbrella bags.

The Okinawan sweet potato—called beni imo—was introduced to the islands in 1605 by a man called Sokan Noguni. Noguni is revered to this day as a local hero, the “Imo King,” for bringing this miracle vegetable to the islands. “Since the sweet potato came here from China via South America, Okinawans have eaten pretty much nothing but that, along with fish. At one point in their history they were getting 60 percent of their calories from sweet potatoes,” enthused Willcox. Complex carbohydrates are an important part of the Okinawan diet, contrary to several current Western diet fads. Willcox guffawed loudly when I asked about the Atkins diet. “Of course you lose weight with Atkins at the start, but you lose water and lean muscle. You actually increase body-fat percentage.

“Sweet potatoes are high in flavonoids, which are antioxidants and hormone blockers. Okinawans consume more flavonoids than anyone else in the world, up to fifty times more than we do in the West. They [the potatoes] are also rich in carotenoids, vitamin E, fiber, and lycopene, which is a carotenoid that has been shown to help prevent prostate cancer.” In fact, one beni imo contains four times the daily vitamin A and half the vitamin C requirements of an adult. Recent research has also indicated that they help stabilize blood-sugar levels and lower insulin resistance.

Of course, what the Okinawans eat is only part of the explanation for their remarkable longevity. As far as Willcox is concerned, what they don’t put into their mouths is as important. In his view, calorific restriction—in other words, not eating very much—is the key to a long life. “Calorific restriction has been shown to work in all other animal species, including primates, so I’d be very surprised if it didn’t work with humans,” he said. “There are so many connections to obesity and health.”

“So, what kind of restriction are we actually talking about?” I asked, now slightly nervous.

“Well, back in the 1960s, a study showed that Okinawan children were consuming almost 40 percent fewer calories than other Japanese children, so you can imagine how that would compare to the children in the West. At the same time, Okinawan adults were eating more than 10 percent fewer calories than the normal, healthy recommended level.” On average, Okinawans eat 2,761 calories per day, compared to 3,412 in the UK and 3,774 in the United States. Of course, part of this is explained by the fact that they are physically smaller than we are, but personally, I have quite some scope for cutting back.

Eating less is deeply ingrained in both the Okinawan psyche and quite possibly their genes, too. Typhoons, disease, poverty, and their geographical isolation have meant that Okinawans have endured frequent famines. They have adapted accordingly, eating what we in the West would consider emergency-ration quantities on a day-to-day basis. They even have a phrase to describe this philosophy: hara hachi-bu, meaning “Eat until you are 80 percent full.”

It is said that the three words that have earned more money for the beauty industry than any other promotional or advertising strategy are rinse and repeat on a shampoo bottle. Well, here are two and a half words that could wipe out the entire health, beauty, diet, and exercise industries in a trice. Hara hachi-bu could transform the health of the entire world, if only we could all find the self-control. It is based on the simplest of physiological principles—it takes your stomach’s stretch receptors twenty minutes to tell your brain you are full, so if you eat until you feel 80 percent full and just wait twenty minutes, you will feel properly full. Try it. It works. (It also explains my confusion at the discomfort I always feel after being allowed near all-you-can-eat buffets.) In the course of our evolution as a species, it is only in the last century or so that a large proportion of the human race has been in the position of having a surplus of food, but our bodies are still physically attuned to having far less.

This got me thinking about diet fads. For the last decade or so in the West, we have been brainwashed into thinking the Mediterranean diet is best. “It is also good,” said Willcox. “Sardinians, for example, tend to live long, but there is perhaps too much dairy [in their diets] still.”

Usually, when a group of two or more people are gathered and the talk turns to how healthy the Japanese are, someone will confidently assert that osteoporosis rates are much higher in Japan than in the West “because they don’t get enough calcium because they don’t eat dairy.” This is a myth. “Osteoporosis rates are actually lower in Japan,” Willcox told me. “They get more exercise and vitamin D. Smoking is a problem, though; lung cancer rates are increasing. That’s a problem now because it can take twenty or thirty years for the cancer to appear, and if you look twenty or thirty years ago, to the 1980s, 80 percent of Japanese men were smoking.”

The Willcoxes and Suzuki have a great deal to say about fat in their book, too, mostly negative. “Really, less than 10 percent of your calories should come from fat, but a little pork is a good addition for the protein,” Willcox said. And guess which meat the Okinawans have traditionally eaten more of than any other? In fact, they are renowned for their pork cuisine and have a saying that they claim originated with them: “With a pig you can eat everything except the oink.”

So even when Okinawans are eating bad stuff, it’s doing them good. The same goes for the famous (in Japan at least) Okinawan black sugar, a dense, malevolent-looking cane sugar called kokuto that tastes wonderfully rich, like molasses or muscovado. “It is true; their sugar is much better because it isn’t processed or bleached. It also has more iron in it. But as with the salt, you still want to stay away from sugar if you can,” he said.

But dietary and medical factors are still only part of the secret of Okinawan longevity. The improved postwar health care eventually trickled down to Okinawa at a time when those who had endured the war—by definition the most resilient of their generation—were entering middle age. Yet they still ate the traditional Okinawan diet, and so this “survival of the fittest” factor, combined with modern health care, proved to be a potent longevity tonic for a specific demographic, which is now reaching—and flying past—the century mark.

According to Willcox, the fact that they appear to be the least-stressed people on earth plays a role, too. The Okinawan concept of time pays scant regard to the tyrannies of the clock, which makes it difficult ever to be late. He also believes their supportive localized social structures—called uimaru—are immensely important to their longevity. One aspect of this is the maoi, or local “people’s banks,” where around a dozen or so friends meet and contribute a small sum to a kitty, then each month vote to decide who gets the money. Meanwhile, their health care systems incorporate both traditional medicines and healers—called yuta—and tai chi is widely practiced. Interestingly, one of the reasons given for the superior longevity of Okinawan women in particular is that they are more likely to practice a religion—a belief in a higher power supposedly giving them a greater sense of ease and contentment.

And there is no word in the Okinawan dialect for retirement. Many of the centenarians Willcox and his team have interviewed continue, if not to work in full-time jobs, then at least to tend their gardens, grow vegetables, and even have part-time jobs. So while in the West there is growing concern, a resentment even, that people are living longer and becoming a burden on public health care finances, the centenarians of Okinawa are more of a boost than a burden.

In Okinawa, it is usual for the elderly—including centenarians—to live in their own homes. In his book, Willcox describes his centenarian subjects’ “youthful glow” and “sharp, clear eyes, quick wits, and passionate interests.” They don’t suffer from “time urgency,” he writes; they are very self-confident, self-reliant, optimistic, and easygoing but also stubborn.

“What about … you know…?” I raised my eyebrows.

“What? Their sex life?” He laughed. “Now, that would be an interesting area of research. We do know that Okinawan centenarians have higher levels of sex hormones, and we do know that some of our centenarians are sexually active, but I don’t think we could really get away with asking them about that.”

Sadly, Willcox told me that it looks like the age of Okinawan longevity is coming to an end. The next generation is unlikely to last much beyond eighty, as they have embraced the American fat- and sugar-rich diet with gusto—young Okinawans are eating twice as much meat as their parents, for instance—with the result that Okinawans aged fifty and below have the highest rates of obesity in Japan, with, inevitably, the highest rates of heart disease and premature death. The last few decades have seen Okinawans go from being some of the leanest people in Japan to having the highest body mass index. Lung cancer rates are on the up, too. Nagoya is about to overtake them as the prefecture with the greatest longevity.

By now, the restaurant owner was starting to clean up in preparation for dinner. I had one last question of urgent personal import.

“I have a friend—not me, you understand, but a friend—who is having a slight problem with hair loss,” I said. “I can’t help noticing that Japanese men do seem to tend to hold on to their hair pretty well. What’s their secret? Is it the seaweed?”

Willcox, who I had long ago noted was blessed with an impressively thick head of wavy brown, lustrous hair, laughed. “Well, they do say konbu is good for [preventing] hair loss, as is perilla, too, but I am afraid you’ll have to tell your ‘friend’ it’s more along the lines of folk advice than scientifically proven.”

I would just have to settle for eternal life, then.

As I drove back up the coast road, past the vast, razor-wired U.S. military base, I reflected on our conversation. Willcox had described the health of elderly Okinawans as being due, in essence, to a balance between four factors—diet, exercise, spiritual well-being, and psychosocial factors, such as friendships and social support systems. As a misanthropic nonbeliever, I couldn’t do much about the spiritual and psychosocial elements in my life, but I vowed to start drinking jasmine tea (I had never as much as tasted tea until Mrs. Shinobu’s ceremony in Tokyo, so this was a major life decision), which Willcox claimed was even better than green tea for lowering cholesterol, and to up my intake of vegetables and fish. Willcox took turmeric supplements every day, too, as do many Okinawans: it is thought that turmeric might help prevent cancer and gallstones.

“Eat as low down the food chain as possible,” Willcox writes in The Okinawa Program. The notion of man as a hunter-gatherer is misleading, he continues. Gathered produce has always far exceeded hunted food in the human diet. Willcox told me that we in the West eat far more protein than we need; we ought to eat only an amount the size of two decks of cards—around three and a half ounces—a day. Perhaps I could start adding a little bit of MSG to my meals to trick my body into believing it is getting more protein than it is, and start eating more tofu, of course. Seaweed is also clearly important. But you have to eat the real stuff; dried is fine, but supplements aren’t nearly as good, apparently.

Recently, Okinawan products like black sugar, the local hirami lemon (thought to have anticarcinogenic properties), and sea salt have become popular “longevity produce” on sale in mainland Japanese cities. It can be only a matter of time before you see them in chic health-food stores in London and New York.

All that remained for me was to see for myself the benefits of healthy Okinawan living. I had to bag me a centenarian.